﻿<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd">
<html xmlns="http://www.w3.org/1999/xhtml" >
<head>
    <title>Edit Diagnosis</title>
</head>
<body>

<div>Edit Diagnosis</div>

<table>
<tr>
<td>
    Diagnosis Name:
</td>
<td>
    <input type="text" name="DiagnosisNameTextbox" />
</td>
</tr>
</table>

<input type="submit" name="SaveButton" value="Save" />

</body>
</html>
